支氣管鏡檢查須知(Flexible Bronchoscopy)
【Learning Points】
- Learn how to force-feed via nasogastric tube.
- Understand the possible complications caused by poor force-feeding methods.
- Learn daily care tips for nasogastric tubes.
I.Why insert a nasogastric tube？
Nasogastric feeding can provide nutrition, give medication, drain fluid and gas from the gastrointestinal tract to avoid bloating and vomiting.
Nasogastric feeding can provide nutrition, give medication, drain fluid and gas from the gastrointestinal tract to avoid bloating and vomiting.
II.Types of nasogastric tubes：
III.Introduce two feeding methods：
- Bolus Feeding : pour into the feeding syringe, feeding diet with 70c.c. syringe, slowly push, the diet can use the homemade or commercial formulations, generally, feeding 250c.c. every 2-4 hours , not to exceed 300 c.c. in total.( Figure 1)
Figure 1. Bolus Feeding - Feeding bag drip feeding: pour diet into the feeding bag, use gravity and control bolt to control speed, continue and slowly drip diet, avoid the uncomfortable sensation, the diet dripping should be slow down. The one who has poor gastrointestinal function need high-calorie, and high-concentrated formula can choose this method. ( Figure 2)
Figure 2. Feeding bag drip feeding
IV.Feeding steps and precautions:
- Before the feeding:
- Wash hands, prepare force-feeding formula, warm water, empty needle or force-feeding bag, and towel.
- Place the patient in a semi-sitting position at 30-45 degrees and do not lie down, if suction is required, suction is drawn first and then feeding.
- Put a towel on the patient's chest.
- Open the spigot of the nasogastric tube by folding it back near the opening.
- Insert a feeding syringe at the end of nasogastric tube then withdraw the syring, to determine the nasogastric tube is in the stomach, and observe the residual amount of gastric fluid. If the total amount of remains in the stomach falls below 100ml or last feeding in the stomach seem to less than 50%, then push it back into the stomach , and tube feeding is allowed to proceed.
- If there is black or coffee colored substance in the residue, immediately stop the feeding and observe the stomach contents again at the next meal, if no improvement should to seek treatment in hospital.
- Feeding in progress:
- Wet the lining of the nasogastric tube with 30 c.c. of warm water. If you feel that the tube is not filling easily, it may be (a) obstruction of the nasogastric tube: reverse the pumping with the empty needle, then flush the tube with warm water and repeat this action several times. (b) obstruction of the tube against the stomach wall: pull out the tube gently by about 2 cm and try filling with warm water, if it still does not work, ask your doctor or home care provider to renew it.
- The temperature of the feeding formula should be close to body temperature.
- The slower the speed the better, 10-15 minutes per meal. if side effects such as nausea, vomiting or diarrhoea occur, consider changing the diet ingredients such as concentration, temperature and speed.
- If the patient keeps coughing or vomiting during the feeding process, stop the feeding immediately, observe closely and contact your home health care provider or take the patient to a nearby hospital.
- After the feeding:
- Rinse the tube with 30-50 c.c. of warm water and cover the opening of the tube to avoid food residue and bacterial growth.
- It takes 30 minutes to lie down or turn over after feeding.
- When finished, wash and dry the utensils in a covered container.
V.Precautions for nasogastric tube care:
- Daily cleaning of the mouth with a sponge toothbrush and nasal cavity with cotton swabs.
- Change the fixed tape daily and check the position of the nasogastric tube to prevent the tube from shifting, the choice of tape should be plain paper tape or pull-together tape, the use of hypoallergenic paper tape is not recommended as it does not fit well and can be easily loosened. increase frequency of replacement if nasal discharge is high or if the nose is prone to oiliness, the paper glue is fixed to the same part of the skin and needs to be replaced in different positions.
- When changing the tape, wipe the nasal skin with water and do not move the insertion depth of the nasogastric tube, which is usually fixed at 45-55 cm (between the 1st and 2nd mark of the nasogastric tube). If the tube is not more than 10cm out, check that there is no tangled nasogastric tube in the mouth, then gently push it in to the original position and re-fix it, then inform the home healthcare provider.
- If there is vomiting, dry nausea, severe coughing, or shortness of breath or a drop in oxygen concentration, re-check the position of the nasogastric tube to see if it has shifted.
- Tapes fixing method:
- The nasogastric tube should be protected from pressure, twisting or pulling out during feeding. if necessary, the patient's hands should be restrained to prevent injury from self-extraction of the tube in unconscious, agitated patients.
- Depending on the material, the nasogastric tube can be replaced at 7 days, 1 month or 3 months. you can apply for home care service or go to a hospital near your home for replacement.
V.Conclusion:
When a nasogastric tube is placed for a long period of time after hospital, the patient or a family must learn how to take care of the tube in order to maintain the function of the tube, improve the quality of care at home and reduce the harm caused by blockage or slipping of the tube.
When a nasogastric tube is placed for a long period of time after hospital, the patient or a family must learn how to take care of the tube in order to maintain the function of the tube, improve the quality of care at home and reduce the harm caused by blockage or slipping of the tube.
VI.References:
- 王琬詳、余佳倫、宋惠娟（2022）．跨團隊鼻胃管照護三部曲．護理雜誌，69(1)，33-40。https://doi.org/10.6224/JN.202202_69(1).06
- 吳尚蓉（2022）．鼻胃管留置病人吸入性肺炎的預防照護．護理雜誌，69(1)，18-24。https://doi.org/10.6224/JN.202202_69(1).04
- 陳韋安、黃亭尹、林意雯、周敏怡(2022)．提升某外科病房居家照顧者執行鼻胃管照護正確率之改善專案．彰化護理，29(1)，51-65。https://doi.org/10.6647/CN.202203_29(1).0007
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- 位置
-
- 資料夾名稱
- English
- 發表人
- 黃郁琇
- 單位
- 中榮護理衛教
- 英文名稱
- Nasogastric Feeding：NG Feeding
- 分類
- 健康促進
- 科別
- 英語
- 癌症照護
- 否
- 建立
- 2024-01-28 22:35:05
- 制訂日期
- 2014-02-25
- 最近修訂
- 2024-03-19 11:52:00